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Navigation: A Guide to Implementing Person-Centred Care September 2012is reasonable to insist on compliance but they are unlikely to accept the argumentsfor change.• Help and support is required after initiation as well as before.• Do not think you can build ownership at the beginning of a change. Involve peoplethroughout the development process.• Beware of “brute sanity.” One of the things that many managers do when trying topromote change is to give lots of clear, loud messages to staff about how wonderfulthe innovation is, how it will revolutionize the service, etc. This is brute sanity.If the messages are said often enough and loud enough, staff will tend to back offand build barriers.Guiding Principles of Knowledge ImplementationIn the national evaluation of Cancer Journey implementation initiatives across Canada,the evaluators established nine guiding principles of knowledge implementation basedon change management literature. Change management knowledge, skills and strategiesare recognized as integral to successful implementation of innovative programs. Theseprinciples are designed to be used as a package, and thus all principles should be appliedto achieve full knowledge implementation and to ensure that managing change isas effective as possible. For definitions of each principle, see Appendix C.Guiding Principles of Knowledge Implementation1. Problem Assessment and Understanding2. Tailoring to Local Context3. Assessment of Individual Perceptions and Motivations4. Barrier Identification and Management5. Identification of Social Influences6. Training and Coaching7. Organizational Capacity Building and Infrastructure Development8. Patient Engagement and Implementation9. Monitoring, Evaluating, Reporting, DisseminatingPricewaterhouseCoopers LLP, 2010b26
Navigation: A Guide to Implementing Person-Centred Care September 2012The Foundations of Implementation PlanningThe following information is intended to guide the management team through somesteps to assess and plan for implementation.As a first step, the management team needs to gatherevidence to support the need for Navigation. How is theclinic or team currently practicing? How satisfied arethe patients with the experience of care? What are thegaps or bottlenecks in care processes? The answers tothese kinds of questions can be used to create key messagesabout how Navigation can solve problems for thepatients, staff, organization, external stakeholders andhealth care system. Some of this data may already beGather Evidence• Picker surveys or otherpatient surveys• Needs assessment andgap analysis• Baseline data from clinicsand disease site groupsavailable from existing surveys, patient data or other sources, but it may need to be collected.Data may be useful to provide a pre-implementation baseline. See Chapter 6,Quality Improvement and Evaluation, for more information on data collection.Next, the management team should assess organizational readiness for change, beginningwith a self-assessment. Does the management team have the knowledge, skills andexpertise to effectively manage change? (See Appendix D: Self-assessment of ChangeManagement Skills for a tool that can be used with individuals and groups.) If these skillsare lacking, the team might consider how to build such capacity, as described below.Leadership, Change Agents and FacilitationImplementing and adapting Navigation is a change process that must be active, managedand participatory. Key components of the process are leadership, change agentsand facilitation (Harrison and van den Hoek, 2010).Leadership: Senior management must lead the change and their commitment is vital(Ellis and Kiely, 2000):• To enable the change process• To ultimately be accountable and responsible for initiating and guiding the changeprocessChange Agents: Change agents are central to the process of managing change effectively.A change agent is an “an individual who influences clients’ innovation decisionsin a direction deemed desirable by a change agency.” (Stetler, Legro, and Rycroft-Malone, 2006) Change agents:• Take the change forward• Provide the right blend of support and pressure to motivate staff• Maintain momentumA great deal has been written about the skills and qualities needed to be a goodchange agent, and learning to be an effective change agent is important.27
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